The Utilization Management team ensures appropriate utilization for optimal patient care. Our priority is to support the patient to make sure that they are getting the best care over a continuum of time to achieve positive clinical outcomes. Utilization Management decisions are based on the medical necessity of care, member's eligibility and benefits.

Some specialty services are available without an authorized referral from your provider, such as well-woman visits, and some health insurance plans do not require you to get an authorized referral to see a specialist. Ask your primary care physician which services you are eligible to receive without prior authorization.

UM Procedures and Criteria are disseminated to members and provider upon request by calling our Customer Service department at (877) 282-8272 Opt.1, Monday through Friday between 9:00AM and 5:00PM. For the hearing impaired, please call our TTY telephone at 866-461-4288, Monday through Friday between the hours of 8:30AM to 5:00PM.